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General NPI Number Information
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NPI Number | 1134913445
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Entity Type | Organization
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Legal Business Name | SOULFUL HORIZON LCSW, PLLC
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Dates
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Enumeration Date | 04/09/2025
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Last Update Date | 04/09/2025
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Provider Practice Location Address
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Address Line | 13729 233RD ST
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City | ROSEDALE
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State | NY
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Zip | 11422-1725
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Country | US
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Telephone | 929-900-3880
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Fax |
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Provider Business Mailing Address
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Address Line | 418 BROADWAY # 6377
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City | ALBANY
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State | NY
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Zip | 12207-2922
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EMMANUELLE LAJEUNESSE
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Credential | LCSW
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Telephone | 929-900-3880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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